In the mid and late 1980s, Thailand was one of the countries hit hardest by the HIV/AIDS epidemic. By 1991, the country's prime minister announced that AIDS prevention and control were a national priority.

Thailand soon became one of the world's first success stories in the battle against the virus, reducing the number of transmissions from 140,000 in 1991 to 23,000 in 2003. Nonetheless, one in every 100 Thais is infected, and AIDS is still the country's leading cause of death.

The Mercy Centre is the first and largest free AIDS hospice in the Thai capital, Bangkok. It is located in the middle of the city's biggest slum, Klong Toey.

The Mercy Centre was established in 1993 by a Catholic priest, Father Joe. Initially, the project was received with disdain and fear by the slum-dwellers, says Usanee Janngeon, one of the centre's health managers.

"When we first began our patients weren't allowed to go outside. But now, they can walk out in the community, buy food and do whatever they want as long as they don't make trouble. The community accepts them. I'm not saying there's no discrimination, far from that. But at least the slum-dwellers have shown acceptance of HIV/AIDS patients."

Mercy Centre kindergarten

Raising Awareness

The Mercy Centre has managed to overcome people's fears through outreach teams which are helping to raise awareness about the virus. For example, it provides information to poor parents who send their children to the pre-schools run by the Centre. The 30 kindergartens provide education to 4,500 children.

"We meet with the parents twice a year. Some of them refer people living in the community to us. They tell us, 'I think my neighbour, her son, her daughter, her husband, his wife, is HIV-positive. Can you do anything to help?' We use the school as much as we can because if anybody in the community has problems, they usually go to the teacher. So we educate our teachers about HIV/AIDS."

Pai is a 72-year-old grandmother. Her son and her daughter-in-law both died of AIDS, leaving behind a 2-year-old boy who also turned out to be HIV positive. Kom Kiau is now 15. Initially the grandmother was reluctant to take care of him.

"I was afraid. I didn't know if AIDS could be easily transmitted or how my grandson got infected. But Kom Kiau is my only grandson so I decided to take care of him, even if I got infected. A local charity and the hospital gave me information about how to look after someone who has HIV.

"I told all my children about his status. I told them if they were scared of catching the disease, they should leave. I'll keep my grandson whatever happens.

"I hope Kom Kiau finishes school and gets a good job, but he doesn't like going to school. He prefers to stay at home. I'm afraid that when I die, he won't have a future. So I'm teaching him to do what I do, which is selling rice porridge. At least then he'll be able to take over from me."

Workload

The Mercy Centre used to take care of over 250 patients a year and served as a shelter for people in the final stages of the disease. But the advent of anti-retroviral drugs has led to a major drop in the number of patients.

The patients are referred by local hospitals and charities. Once they arrive at the Mercy Centre, the staff contacts the family, providing them information to help overcome their prejudices towards the disease. According to Usanee Janngeon, "the family needs to understand that AIDS is not an issue that patients can deal with on their own. All of us have to work together: the Mercy staff, the hospital, the family and the patient."

Care

There are 25 beds at the Mercy Centre. The nurses ensure that the infected people follow their drug regimes, and other staff members help the patients get proper nutrition, remain clean and consult with the family members.

For most, the Mercy Centre is a temporary hospice, says Usanee Janngeon. "We try to create a bridge between the family and the patient as soon as possible. The family needs to be educated and to understand that you can live together with a person who has HIV/AIDS." For those who are homeless and without family, the Mercy Centre is home.

Going home

Three years ago, the Mercy Centre took in at least 200 patients a year. The figure has now dropped to less than 100. Anti-retroviral drugs and the Centre's home-based care teams mean that most patients go back to their families.

"We have 300 patients who are HIV-positive and living at home. We don't visit all of them every month. Some of them are getting better. Some of them are working, and many have very supportive families. So all we do is give them a call once a month and ask if everything is OK. We only visit people who have problems with their family or the community or who have problems getting access to treatment or medication."

Model

The Thai government has recognised that the care the Mercy Centre provides could be a model for the rest of the country. "We are getting financial support from the AIDS Division of the Ministry of Public Health," says Usanee Janngeon. "It's not as much as we would like, but there are a lot of non-governmental organisations in Thailand dealing with the AIDS issue."